Remember! Our guides are to be used following an assessment with a qualified medical professional. Do not attempt these exercises if you have not been given a formal diagnosis, or given consent to complete these exercises by a Physical Therapist.

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Carpal Tunnel Syndrome Physical Therapy Guide

What Is Carpal Tunnel Syndrome?

You’re typing up some notes or playing a game on your computer and suddenly, you get a sharp shooting pain up your arm and through your wrist. It’s not a one off, now you have numbness in your hand and it just won’t go away! It’s more than likely Carpal Tunnel Syndrome (CTS).

Carpal Tunnel Syndrome is the result of compression or squeezing of the median nerve in your arm as it travels through your wrist. The median nerve is responsible for the sensation of the thumb and fingers (palm side), as well as allowing movement of some small muscles in the hand. The carpal tunnel is a narrow passageway that houses tendons and the median nerve. Sometimes, swelling of these tendons and other structures in the area cause the median nerve to be pressed against the tunnel, causing nerve pain in the hand. The prevalence is approximately 50 cases per 1000 people in the general population, however there are certain risk factors that improve your chances of getting it!

Risk Factors

Women are unfortunately, 3 times more likely to develop carpal tunnel syndrome, perhaps because female carpal tunnels are smaller to begin with.

The dominant hand is usually the first to be affected due to its overuse.

People with diabetes and other metabolic disorders are more likely to develop carpal tunnel syndrome.

People performing manual tasks and assembly linetype jobs are almost three times more likely to develop carpal tunnel syndrome than those working with computers!

Causes

Carpal Tunnel Syndrome is usually the result of a combination of risk factors that increase the pressure that is placed on the median nerve in the wrist, rather than a pathology with the nerve itself. More often than not, you are predisposed to getting Carpal Tunnel Syndrome through a combination of your genetics, some people simply have smaller carpal tunnels than others. Other factors include repetitive trauma to the wrist, although in most cases, no cause can be identified.

Symptoms

Symptoms often start gradually over time with burning, tingling or numbness in the hand and fingers, normally the thumb, index and middle finger. People often find that they lose proper functional use the affected area due to pain, and feelings of swelling. With this, grip strength is reduced, making it difficult to grasp objects and complete normal daily activities. In serious cases of carpal tunnel syndrome, the muscles in the wrist and base of the thumb can begin to waste away.

What Are My Treatment Options?

There are multiple treatment options available to people who suffer with carpal tunnel syndrome!

Rest & Time

It is imperative that you try to stop doing the thing(s) that caused the wrist pain to begin with and avoid activities that agitate it further. This can be a wide variety of things that place repetitive strain on your wrist. There are no specific activities to avoid, as it is completely subjective; everyone is different. Throughout your rehabilitation programme you must make note of what to avoid via trial and error. Any time that you feel something is causing the pain to flare up, or if you feel your wrist and hand getting tingles / painful you must take care of the injury site and try to stop the activity. Perhaps the worst thing you can do for this type of injury is to “work through the pain”, tendons do not heal in this way and it will only set you back more time if you do.

Surgery?

Surgery for carpal tunnel release is a very common and successful procedure in the United States, but is normally used as a last resort treatment if symptoms have persistently lasted for 6 months or more. Surgery involves severing the band of tissue around the wrist to reduce pressure on the median nerve. Symptoms often get relieved immediately however, recovery from surgery can bring up its own host of problems such as infection and stiffness and requires even more recovery time. With that in mind, it is always a good idea to see your Physical Therapist to get started on a non-surgical treatment programme.

Carpal Tunnel Syndrome Prevention

There are unfortunately no 100% proven strategies to prevent carpal tunnel syndrome, however there are many precautions that you can take to minimise your risks of developing CTS. These include:

Exercises

Exercise is the most important component for prevention and recovery and one that must not be avoided. These exercises should be done daily; they will take approximately 20 minutes, but will greatly improve your pain, prognosis and recovery time.

Carpal Tunnel Syndrome Exercises

1) Wrist ROM

It is imperative that you continue to maintain and improve the range of movement in your wrist and fingers, as they often get very stiff due to pain and swelling. Its the simplest, yet most effective way to improve your carpal tunnel syndrome. To make the exercise harder you can add weights and slowly strengthen the muscles through movement. Remember “motion is lotion!”

How to do it:

Simple, your wrist moves in multiple directions, throughout the day try and move your wrist in these directionsl

Do not push through pain, if its painful, try something else.

Repeat multiple times throughout the day!

2) Wrist Isometric Strength

It is very important that you try to maintain the muscular strength in your wrist and hand, as the muscle can often begin to waste away if you have carpal tunnel syndrome. Isometric strength training is easy and can be done anywhere! It’s similar to tensing your muscles without moving them.

4) Prayer Stretch

The Prayer stretch is actually used as a diagnosis tool used by Physical Therapists, as it often compresses the median nerve in the carpal tunnel. With that in mind, it is a good idea not to over do this stretch, only use it as a means to stretch the tight muscles in the wrist and forearms gently!

You should feel a mild to moderate stretch under your forearms. Hold this stretch for 10-15 seconds.

Repeat 10 reps, 3 times per day.

5) Pinch Extensions

Using your injured arm, bring your fingertips together as if making a beak shape. Place a rubber band or modified Theraband over your fingers so that it holds the tips of your fingers together. Slowly move your fingers away from each other against the resistance of the band. Repeat 10 times, 3 sets. Try to do this 3 times per day.

6) Tyler Twists

The Tyler Twist exercise is mainly used in the treatment of lateral elbow tendonopathies for forearm strengthening, but it can be beneficial in cases of Carpal Tunnel Syndrome. It requires the use of a Theraband Flexbar, which can be purchased here!

How to do it:

Grasp the Flexbar with your injured arm near to its base and extend your wrist.

Grasp the upper end of the bar with your non-affected arm so that it faces away from you.

Twist the bar with the top hand as you stabilise with the bottom hand.

Hold both wrists steady as you extend both elbows in front of you. The wrist on your injured side should be extended whilst the other wrist is flexed.

Slowly release the bar with your injured side, while maintaining tension with the uninjured side.

The more twisting motion you can apply with your uninjured side to begin with, the better the resistance will be for the injured side.

Repeat 10 reps, 3 sets, try to do this 3 times per day.

Prognosis

Left untreated, carpal tunnel syndrome can last anywhere between 2 weeks and 2 years, with high chances of the condition returning if you do not take action. Most patients show significant improvement after 6 weeks of Physical Therapy treatment however it can take up to a year to show full improvement. To reduce your chances of getting carpal tunnel syndrome again, you must continue to strengthen and stretch your forearm, wrist and hand muscles. Taking breaks from activities that involve long periods of loading will also prevent trauma and if you feel some pain coming on, you must try and cease that activity immediately.

If symptoms continue to persist, there are a range of non-surgical and surgical treatments available to you that aim to relieve the pressure on the median nerve, talk to your medical professional.